Anomalous origin of the coronary left artery in the pulmonary artery (ALCAPA) in adult patient with ventricular left dysfunction .a propos of a case.Rojas, Elirub; Navarro, José Manuel; Herrera, Robert & Bosch, Fernando

Abstract

The anomalous origin of the Coronary Left Artery in the Pulmonary Artery is a congenital rare cardiopathy, which affects 1 of every 300.000 childbirths (1) Represents 0,25 to 0,50 % of all congenital cardiopathies (2) It was first described by Brooks in 1886 being one of the first causes of death in children (90 %) for isquemia and heart attack; presentation in adult is rare and corresponds to 10-15 % of the cases (1) OBJETIVE:: To describe a case of ALCAPA an adult with systolic dysfunction of the Left Ventricle FE 20 % PRESENTATION OF CLINICAL CASE: 44-year-old female patient, whose simptomatology began two years ago, when presented difficulty in breathing to moderate or slight efforts as well as progressive edema in lower legs, throbbing and nauseas, symptomatology persists and difficulty in breathing progresses to ortopnea, being hospitalized by this cause. At admission: TA:110/60 mmHg PAM:110 mmHg FC:107 lat/m, FRES:17rpm DEALS: 165CM PESO:62KG IMC: 22,7. Disneic, diaphoretic, does not tolerate dorsal, Cardiovascular decubitus: venous jugular pulse +8Ccm, wave To giant, LSPEI, apex visible and palpable in 5TO EII/2cm externally LMC, area 2 cm hipokinetic, carotid pulse of form and normal extent. R1 only one, R2 only one, R4. Symmetrical thorax hipoexpansible, crackling bilateral in 1/3 with vibrations abolished in bases, abdomen: globular, RSHSPS signs of big wave +, hepatic edge to 3 cm of the costal curbing, extremities edema II/IV, symmetrical, stops fovea. Electrocardiogram reports: RS/CAI/HVI/BSARIHH/ZEI septal, subepicardic isquemia, SSVI. transtoracic Ecocardiogram shows: left ventricle expanded with hipokinesia, severe low and previous way - apical, Fe 20 %, moderate expansion of left auricle and right ventricle, aortic valve and aorta with expansion of coronary right artery of 7-8mm, exit of coronary left artery of the aorta was not found, pulmonary pressure 50mmhg. AngioTAC is realized without evidence of abnormality and coronary angiography shows: dominant right coronary artery, of great calibre, with ectasia, originating from the trunk of the pulmonary artery of great calibre. She receive surgical treatment consisting of ligature of the coronary left, aortocoronary bypasses to descending and marginal obtuse arteries, and mitral anuloplasty with Edwards ring 32mm, She is discharged asymptomatic. Control 6 months later shows Fe 55 % . DISCUSSION: Ussually asymtomatic began with sudden death having an incidence of 85-90 % in middle age, for this reason it constitutes a severe pathology that needs surgical correction. The success of the coronary reimplant is correlated with substantial improvements in valvular function. Patients with ALCAPA controlled opportunely show good recovery, depending on the presence or not of isquemia and previous hearts attacks, age, and ventricular function, experience of the surgical group being an important factor. (4,5)